Trofymenko O, et al. - The factors associated with advanced stage Merkel cell carcinoma (MCC) at the time of initial diagnosis and the use of radiation therapy (RT) were determined. Healthcare models should consider these factors, and efforts should be directed toward improving the factors that are modifiable.

Methods

• Researchers performed a cross-sectional, retrospective analysis of MCC patients registered in the National Cancer Database during 2004-2013.

Results

• Researchers identified a total of 11,917 patients.
• From the staging and RT analyses, 3,152 and 4,586 patients were excluded, respectively, due to lack of available data.
• At the time of initial diagnosis, advanced stage MCC could be predicted via African American ethnicity (OR, 1.49; 95% CI, 1.06-2.10; p=0.023), lack of medical insurance (OR, 2.15; 95% CI 1.40-3.30; p<0.001), a Charlson/Deyo comorbidity score of at least 1 (OR, 1.21; 95% CI, 1.09-1.34; p < 0.001), residing more than 26 miles from a treatment facility (OR, 1.18; 95% CI, 1.03-1.35; p=0.015), tumor located on the lower limb/hip (OR, 1.59; 95% CI, 1.42-1.78; p < 0.001) or trunk (OR, 2.05; 95% CI, 1.81-2.33; p < 0.001), and poorly (OR, 2.57; 95% CI, 1.13-5.82; p=0.024) or undifferentiated (OR, 3.11; 95% CI, 1.36-7.15; p=0.007) tumor histology.
• The use of RT was observed in association with Native American ethnicity (OR, 5.04; 95% CI, 1.10-22.99; p=0.037), tumor size between 1.5-2.7 cm (OR, 1.27; 95% CI, 1.10-1.47; p=0.001), electing not to have surgery (OR, 2.77; 95% CI, 1.90-4.03; p < 0.001), positive post-surgical margins (OR, 1.39; 95% CI, 1.18-1.63; p < 0.001), and receiving treatment at a comprehensive cancer program (OR, 1.25; 95% CI, 1.03-1.50; p=0.020).